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| Question |
| 1 | Does your child make use of any words? |
| 2 | Does your child request what is desired through the use of words? |
| 3 | Does your child label objects and images? |
| 4 | Does your child demonstrate vocal imitation of words? |
| 5 | Is your child able to describe past time events? |
| 6 | Is your child able to fulfill missing words or parts of them in songs? |
| 7 | Is your child able to fulfill missing words of neutral statements or phrases? |
| 8 | Is your child able to vocally answer questions? |
| 9 | Does your child attend to you and others after being called by the name? |
| 10 | Does your child receptively follow instructions? |
| 11 | Does your child imitate modeled actions with and without use of toys? |
| 12 | Is your child able to match objects and/or pictures to their corresponding samples? |
| 13 | Is your child able to manipulate age-related puzzles appropriately? |
| 14 | Is your child able to remain seated for a long time to work on an activity with an adult? |